Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Blake Hamilton Gilliam

Individual provider Gerontology Nurse Practitioner · NPI 1043845787

Mr. Blake Hamilton Gilliam is a Gerontology Nurse Practitioner in Madison, Alabama. Practices as a sole proprietor. Licensed in Alabama.

Licensed in
AL
In the registry since
2020
Specialties on file
3

Practice location Address checks out

1230 Slaughter Rd Ste C
Madison, AL 35758-5901
Phone: (256) 325-0955
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 1-153719 (AL)
Gerontology Nurse Practitioner Taxonomy 363LG0600X · Licence 1-153719 (AL)
Acute Care Nurse Practitioner Taxonomy 363LA2100X · Licence 1-153719 (AL)

Record details

NPI number1043845787
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMarch 3, 2020
Last updated in NPPESMarch 3, 2020
Certification dateMarch 3, 2020
Mailing address1230 Slaughter Rd Ste C, Madison, AL 35758-5901

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